Individual
DR. JOHN ANDREW WILD
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
DC
Contact information
Practice address
905 MAIN STREET, SEWARD, NE 68434-2072
(402) 643-6565
(402) 643-4655
Mailing address
905 MAIN STREET, SEWARD, NE 68434-2072
(402) 643-6565
(402) 643-4655
Taxonomy
Speciality
Code
Description
License number
State
111N00000X
Chiropractor
Primary
1017
NE
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1780679704
NPI
NE
01
—
272174
MEDICARE PTAN
NE
01
—
350046510
MEDICARE RR
NE
01
—
470825365
TAX ID #
NE
05
—
47082536500
—
NE
Enumeration date
09/15/2005
Last updated
11/10/2015
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